Firefighter/EMT Suicide Screening

Below is a self-screening for suicide ideations for firefighters/EMT. Please circle either Y= Yes, or N=No. When you have completed screening please review your score at the end of the screening.

Are you feeling like a burden to your family, friends, or Fire Company or EMS organization? Y/N

Do you feel the world would be a better place without you in it? Y/N

Have you started to isolate yourself from others in the firehouse or EMS location? Y/N At Home? Y/N

Have you found yourself turning to alcohol or other addictive behaviors to make yourself feel better? Y/N

Have you or someone close to you noticed that your sleeping patterns have changed? Y/N

Are you thinking, “What’s the use?” when going to the firehouse or responding on calls? Y/N

Do you find yourself thinking about or performing unnecessary risks while at a fire scene or on an emergency incident? Y/N

Have you found an increased or new interest in risky activities outside the firehouse/EMT organization such as: sky-diving, reckless motorcycle riding or purchasing guns? Y/N

Are you displaying unexplained angry emotions or have you been disciplined recently for anger towards other firefighters/EMTs? Officers? Or the Public within the last few months? Y/N (Any option will receive a circle of Yes)

Have you been told that “you have changed” by: Friends? Family? Fellow coworkers? Y/N (Any option will receive a circle of Yes)

Does your family have a history of a suicide? Y/N

Do you have a history of feeling depressed? Y/N

Do you have feelings of hopelessness? Y/N

Do you feel like killing yourself? Y/N

Have you created plans to kill yourself? Y/N

Have you recently attempted to kill yourself? Y/N

Scoring: Total the amount of (Yes) circled.
Score:__________

If you circled question 14, 15 or 16, SEEK HELP IMMEDIATELY by

Dialing 911

or calling the National SuicidePrevention Lifeline1-800-273-8255

or calling the Share the Load Program 1-888-731-3473

Once you have reached one of the above, call a trusted family member, friend, chaplain, or counselor.

Firefighter Behavioral Health Alliance (FBHA) recommends that if a person answers YES to at least three of these questions, it would be recommended that you contact a local Mental Health Care Professional that deals with firefighters/EMTs that suffer from suicidal ideations and depression. If you need assistance in finding a counselor in your area, contact FBHA for further information at 847-209-8208.

Confidential Firefighter Suicide Report

In order for FBHA to be able to serve the needs of the fire service family, the more information we can gather on the firefighter suicide mechanism for pro-active training, the better. By gathering as much information as we can, we can provide a profile that helps identify at-risk firefighters before this tragedy strikes. This information has proven to be an invaluable tool for the police service.
We request that anyone having information on a firefighter suicide please contact FBHA using the form below. Because we are mindful that some agencies prohibit the release of information by their Departments, and that some family members may not be aware that there is a way to make notifications, we have developed a "blind form" that assists in providing anonymity for the submitting party. This form has been graciously given to FBHA to use from Robert E. Douglas, Jr. of the National P.O.L.I.C.E. Suicide Foundation. Once you submit this confidential form, it is transmitted to Firefighter Behavioral Health Alliance's email, with the sender information removed. Since we have no means to contact the submitter back because that information is blocked, we appreciate as much information as you can provide. FBHA then uses this information to keep its training pro-active and post-event, current.
At a minimum, we require the agency's name, state, firefighter's sex, rank, years of service, date of death, how death occurred, and any stressors identified or suspected as being a catalyst. We would appreciate any additional information or details that can be provided.
It is FBHA's policy not to release firefighter or department specific information. We respect the privacy of the families and agencies involved. It is not our intention to cause any undue pain to families or agencies. Additionally, we do not release this specific case information to the media.
Sincerely,
Jeff Dill
Founder
Firefighter Behavioral Health Alliance